Etoposide (Oral)

Overview

In the US, etoposide is sold under the brand name Vepesid. The drug is only available with a prescription from a treating physician and comes as capsules or liquid-filled capsules.

Etoposide (VP-16) is used, together with certain other chemotherapy drugs, to treat patients who have small cell lung cancer or testicular cancer. The drug is also sometimes used in a pre-treatment regimen prior to a stem cell or bone marrow transplant procedure.

Etoposide is one of a class of medications known as 'antineoplastic agents'. It is thought that the drug interferes with the development and growth of cancerous cells, eventually destroying them. Unfortunately, the drug also impacts on other cells, resulting in some side effects. In some cases, the effects may not be seen until months or even years post-treatment. Some of the effects are serious. It is, therefore, recommended that you discuss the risks and benefits of your treatment with your oncologist before you begin taking etoposide.

Conditions Treated

  • Certain cancers
  • Pre-treatment for stem cell or bone marrow transplant procedures

Type Of Medicine

  • Antineoplastic agent
  • Chemotherapy
  • Capsule
  • Liquid-filled capsule

Side Effects

Together with the effects it is designed to produce, etoposide can cause side effects, some of which can be serious. You may not experience all of these effects, but if they do arise, you may need to seek further medical attention.

If you experience any of the side effects listed below while you are using etoposide, you should check with your healthcare professional immediately:

  • Jaundice
  • Wheezing
  • Feeling unusually tired or weak
  • Unusual bleeding or bruising
  • Breathing difficulties on exertion
  • Tightness of the chest
  • Swollen glands
  • Sweating
  • Stomach cramps
  • White spots, sores, or ulcers on the lips or in the mouth
  • Sore throat
  • Slow or rapid heartbeat
  • Skin rashes
  • Shortness of breath
  • Seizures
  • Feelings of restlessness
  • Reddening of the face, arms, neck, and upper chest
  • Eye irritation and reddening
  • Red skin lesions, sometimes with purple centers
  • Swelling or puffiness around the eyes, eyelids, face, lips, or tongue
  • Pounding in the ears
  • Red pinpoint spots on the skin
  • Pale skin
  • Difficult or painful urination
  • Numbness or tingling in the toes or fingers
  • Nervousness
  • Nausea or vomiting
  • Muscle tremors
  • Pain in the lower back or side
  • Poor appetite
  • Joint or muscle pains
  • Itching
  • Hives
  • Headache
  • Fever
  • Feeling of warmth
  • Drowsiness
  • Dizziness, faintness, or feeling lightheaded when rising suddenly from a prone or seated position
  • Feeling dizzy
  • Difficulty swallowing
  • Breathing difficulties
  • Diarrhea
  • Dark urine
  • Cough or hoarseness
  • Confusion
  • Chills
  • Chest pain
  • Bone pain
  • Blurred vision
  • Blood in the stools or urine
  • Peeling, blistering, or loosening of the skin
  • Bleeding gums
  • Tarry, black stools
  • Severe stomach or abdominal pains

There are some side effects that are caused by etoposide that do not generally need further attention, as they will go away once your body gets used to the new drug. Your oncologist or doctor may also be able to suggest ways in which you can manage or prevent these effects. However, if these effects prove to be persistent or bothersome, you should check with your doctor:

  • Weight loss
  • Swelling or inflammation inside the mouth
  • Feeling unusually sleepy or drowsy
  • Pain or burning in the throat
  • Loss or lack of strength
  • Heartburn
  • Thinning hair or hair loss
  • General feeling of discomfort or illness
  • Cracked lips
  • Constipation
  • Change in taste
  • Unpleasant or unusual aftertaste

Some patients may experience side effects that are not mentioned here. If you do notice other effects that are not listed in this guide, have a chat with your doctor or treating specialist.

Dosage

You should only take your prescription of etoposide as you have been direct to by your treating physician. You must not take more or less than the prescribed dose, or use it more frequently than you have been told to. Changing the dose that has been calculated for you may lead to an increase in side effects or could mean that the drug does not work and your condition will not improve.

If you are taking etoposide in combination with other medication, be sure to take each one at the correct time, as per your doctor's directions. Do not mix the drugs together. If necessary, your treating physician will be able to suggest a way of ensuring that you take your medications at the right time.

This medication frequently causes feelings of nausea and poor appetite, which can be severe in some patients. However, you must continue to take the drug, even if it makes you feel really sick. If you are affected in this way, ask your nurse or doctor for ways in which you could mediate these effects. If you do vomit after taking one of your doses of etoposide, speak to your doctor for instructions on when to take your next dose.

When you are handling the blister packs that contain the medicine, it is advisable to wear impervious gloves to prevent exposure to the drug. Ask your doctor for a supply of suitable gloves.

Note that the dose of this medication will not necessarily be the same for every patient. You must take your medicine in accordance with your doctor's orders or as per the instructions on the product label. If your dose is not the same, do not change it unless you are told to do so by your treating physician.

The dose that you are given will depend on how strong the preparation is. The number of daily doses, the time you leave between them and the total duration of your course will all depend on the medical condition you are being treated for and on how your body responds to the drug.

For small cell lung cancer 'capsules:

The usual dose of etoposide is twice the IV dose rounded up to the closest 50 mg, taken daily for four days. The dose is then adjusted to 50 mg daily for five days.

  • Adults: Your dose will depend on your body weight and will be calculated by your treating physician.
  • Children: Your child's treating physician will work out the dose rate and frequency of use.

If you omit a dose of your medication, try to take it as soon as you can. However, if it is almost time for the next capsule, leave out the one you missed and go back to your regular dosage regimen. Do not take two capsules.

Never share your medication with anyone else.

Interactions

Some medicines must never be used at the same time, as doing so could cause a serious interaction to take place. In such cases, your doctor may decide to change your dose of one or both of the drugs, or may recommend other precautions that you can take. You must tell your doctor if you are taking any other medicines before you begin using etoposide.

It is not recommended that you use etoposide while you are also taking any of the drugs listed below. However, if doing so is the best option for your treatment, your doctor may adjust the dose rates or frequency of use:

  • Yellow fever vaccine
  • Warfarin
  • Varicella virus vaccine
  • Valspodar
  • Typhoid vaccine
  • St john's wort
  • Smallpox vaccine
  • Live rubella virus vaccine
  • Live rotavirus vaccine
  • Live poliovirus vaccine
  • Live mumps virus vaccine
  • Live measles virus vaccine
  • Live influenza virus vaccine
  • Glucosamine
  • Echinacea
  • Dasabuvir
  • Cyclosporine
  • Cholera vaccine, live
  • Live bacillus of Calmette and Guerin vaccine
  • Adenovirus vaccine

Some drugs may interact with certain foodstuffs, tobacco or alcohol, potentially causing unwanted effects. You should discuss this aspect of your treatment with etoposide with your doctor before you begin using this drug.

In the case of etoposide, you should try to avoid eating grapefruit or drinking grapefruit juice while you are taking this drug, unless you are told that it is safe to do so by your doctor. Certain chemicals contained in grapefruit can affect how etoposide is removed from your body, which in turn may affect how the drug actually works.

Medical interactions

Some existing or historical medical conditions can affect how etoposide works. Be sure to discuss your medical history fully with your treating physician before you start your course of treatment with this drug.

If you have any form of infection, you should not use etoposide, as the drug can reduce your body's ability to fight off infection.

Etoposide should be used with caution in patients who have kidney disease. This is because the drug may be removed more slowly from the body, potentially leading to overdose.

Patients who have low serum albumin content in their blood should use etoposide with caution, as the drug can increase their risk of suffering serious side effects.

Warnings

When you are considering using a particular medicine, you should first take into account the benefits versus the risk of doing so. This is a decision that you should make with guidance from your treating physician.

While you are using etoposide, you will be required to see your oncologist and your doctor for regular check-ups to make sure that the drug is not causing problematic side effects and to ensure that it is working as desired. You may be required to have blood tests during these appointments.

You must inform your doctor if you know that you have allergies to any forms of medicines, including over the counter products, vitamins, and herbal remedies. You should also mention if you are allergic to food preservatives, colors, animal by-products or specific food groups.

Geriatric

Although studies to date have not shown any problems that relate specifically to the use of etoposide in elderly patients, geriatric patients are more likely to suffer from kidney problems, so an adjustment to the dose may be necessary in these cases to avoid overdosing.

Pregnancy and breastfeeding

Etoposide presents a risk to the fetus. However, if you have a serious form of cancer, the benefits of using this drug may outweigh the risks in a life or death situation. You should discuss this with your doctor before deciding on the best course of action.

Throughout your course of treatment with etoposide, you should use an effective form of contraception to avoid accidentally becoming pregnant. If you are already pregnant, you should avoid handling the drug, as it can be absorbed into the body via the lungs and skin.

Although there are no studies that show a definite risk to nursing infants whose mothers are taking this medication, it is advised that you exercise caution. If you are breastfeeding while taking etoposide, there is a good chance that your infant may ingest the drug through your breast milk and serious side effects could result. Discuss an alternative method of feeding your child with your doctor or midwife.

Medical conditions

Etoposide can cause a serious allergic reaction called anaphylaxis in some patients. This is a potentially life-threatening condition. If you experience any of the symptoms listed in the bullets below within a few minutes of taking the medication, you should call 911 immediately:

  • Chills
  • Fever
  • Fainting
  • Feeling dizzy or lightheaded
  • Rapid or pounding heartbeat
  • Facial swelling
  • Swollen throat or tongue
  • Breathing difficulties

Etoposide can cause a fall in the levels of white blood cells in the blood. This can present an increased risk of infection. Your blood platelet count may also be lowered, meaning that your blood will not clot properly if you sustain an injury. There are a number of simple steps that you can take to avoid bleeding or infection:

  • Where possible, try to avoid contact with people who may have an infection. If you develop a chill or fever, cough or hoarseness, pain in your lower back or side or if you find urination painful or difficult, you should check with your doctor.
  • Unusual bleeding, blood in your urine or stools, tarry, black stools or red pinpoint skin spots should be reported to your doctor immediately, as these could be signs of bleeding.
  • When brushing your teeth or flossing, exercise care. You may also wish to ask your dentist for advice on alternative ways of cleaning your gums and teeth. When attending your dentist, be sure to mention that you are taking etoposide.
  • Avoid touching the inside of your nose or your eyes, unless you have recently washed your hands.
  • Be very careful when cutting your fingernails, using a razor or preparing food, so that you do not cut yourself.
  • While you are taking etoposide, do not play contact sports or undertake any other activity where you could sustain bruising or be injured.

In rare cases, etoposide can cause leukemia. If you are concerned about this aspect of your treatment, discuss the risk with your treating physician.

There are certain vaccines that you should not be given while you are taking etoposide as an interaction and side effects could occur. Before agreeing to have any form of vaccines, including flu shots, be sure to tell your doctor that you are taking this drug.

Storage

Keep your prescription of etoposide capsules in the blister packaging they are supplied in until you are ready to take one.

Keep the package in your refrigerator, out of direct sunlight and away from heat sources. Do not freeze the medicine.

Take precautions to ensure that children or pets do not access this medicine. If a pet does consume etoposide, you should consult your emergency vet immediately.

Do not use any medication that has passed its use-by date or where the packaging appears damaged. Do not keep any unwanted supplies of etoposide. Chemotherapy drugs are very potent and can be highly toxic to the environment. Do not flush unused capsules down the drain or toilet.

Wrap unwanted drugs in a bag and seal it. Place the bag in the bottom of your garbage can where it cannot be found by pets or children. Alternatively, ask you doctor or pharmacist to dispose of unwanted etoposide for you.

Summary

Etoposide (VP-16) is an antineoplastic agent. It is a chemotherapy drug that is used in combination with other medicines to treat certain forms of lung and testicular cancers. Patients who are scheduled for bone marrow or stem cell transplants may also be given etoposide as a pre-treatment.

The drug is very effective, but it does often cause side effects, some of which are serious. You will need to attend your doctor regularly for progress checks and blood tests to make sure that the drug is working correctly and to check for any side effects. There are some medical conditions that may preclude the use of etoposide. For these reasons, you should discuss your medical history with your oncologist before you begin your course of treatment.

Etoposide can present a danger to the unborn baby. Pregnant women should not take or handle this drug unless they have been specifically told to do so by their oncologist.

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